Shock & Hemodynamic Monitoring

Distributive vs. Obstructive vs. Hypovolemic

What shock is your patient in?

types_of_shock

When it comes to shock, putting it all together and figuring out what type of shock your patient is in will drive treatment and intervention decisions. But what type of shock is your patient in? How can you tell?

If you have some basic hemodynamic information, like central venous pressure (CVP), systemic vascular resistance (SVR), and cardiac output (CO) it’s pretty easy to distinguish between hypovolemic, obstructive, and distributive shock types. Let’s take a quick look at all three below:

 

Hypovolemic Shock

(eg. Hemorrhacic shock) : CVP down, SVR up, CO down

In hypovolemic shock a patient has low blood volume and likely needs fluids to fix the problem (be it crystalloids or colloids). They will most likely be tachycardic to try and compensate for low preload / low stroke volume and therefore have a low cardiac output (CO). Their systemic vascular resistance (SVR) will be increased.

Obstructive Shock

(eg. Cardiogenic Shock) : CVP up, SVR up, CO down

In obstructive shock a patient will have a high CVP (and therefore a higher preload) due to the mechanical inability of the heart to effectively pump blood. Systemic vascular resistance (SVR) will also be up as the body vaso-constricts to compensate for the low cardiac output (CO)

Distributive Shock

(eg. Sepsis / Septic Shock) : CVP down, SVR down, CO up

In distributive shock, the patient is globally vaso-dialated and therefore has low central venous pressures (CVP), low pulmonary capillary wedge pressures (PCWP), and decreased peripheral vascular resistance (PVR). To compensate, the patient will present with an increased cardiac output (CO) sometimes over 10 liters per min

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